Unhappiness and depression are totally different things. There is nothing more infuriating to a depressed person than to be told to cheer up, or to be offered jolly little solutions as if they were merely having a bad week. It feels like being told to cheer yourself up by going out dancing after you’ve broken both your legs. (Location 331)

Tags: depression

Note: Depression and unhappiness are very different.

But Irving was also one of the leading experts in the world in a field of science that began right back in Bath when John Haygarth first waved his false wand. At that time, the English doctor had realized that when you give a patient a medical treatment, you are really giving her two things. You are giving her a drug, which will usually have a chemical effect on her body in some way. And you are giving her a story—about how the treatment will affect her. (Location 413)

Tags: story, medicine

Note: .medicine give a drug which has a chemical effect and a story about how the treatment will effect her

“publication bias.”7 Of all the studies drug companies carry out, 40 percent are never released to the public, and lots more are only released selectively, with any negative findings left on the cutting room floor. (Location 475)

Tags: drugs, pharma

Note: 40% of pharma studies are never released as they do not have the results the companies want

Scientists measure the depth of someone’s depression using something named the Hamilton scale, which was invented by a scientist named Max Hamilton in 1959. The Hamilton scale ranges from 0 (where you’re skipping along merrily) to 51 (where you’re jumping in front of trains). To give you a yardstick: you can get a six-point leap in your Hamilton score if you improve your sleeping patterns. What Irving found is that, in the real data that hadn’t been run through a PR filter, antidepressants do cause an improvement in the Hamilton score—they do make depressed people feel better. It’s an improvement of 1.8 points. (Location 494)

Tags: depression, hamilton scale, sleep

Note: sleep has a bigger impact on depression than antidepressants

A short while later, Irving was handed another leaked study. This one struck me especially hard when I read about it, because it was talking directly about a situation I had been in. Not long before I started taking Seroxat (also marketed as Paxil), the drug’s manufacturers, GlaxoSmithKline, had secretly conducted three clinical trials into whether Seroxat should be given to teenagers like me. One study discovered the placebo worked better; one study showed no difference between the drug and placebo; and one study showed mixed results. None showed a success. Yet, in a partial publication of the results, they announced: “Paroxetine [another name for the drug] is effective for major depression in adolescents.” (Location 524)

Tags: placebo, gsk

Note: placebo can work as well as drugs

Professor David Healy, in his clinic in Bangor, a town in the north of Wales. He has written the most detailed history of antidepressants we have. When it comes to the idea that depression is caused by low serotonin, he told me: “There was never any basis for it, ever. It was just marketing copy. At the time the drugs came out in the early 1990s, you couldn’t have got any decent expert to go on a platform and say, ‘Look, there’s a lowering of serotonin in the brains of people who are depressed’ … There wasn’t ever any evidence8 for it.” It hasn’t been discredited, he said, because “it didn’t ever get ‘credited,’ in a sense. There wasn’t ever a point in time when 50 percent of the field actually believed it.” In the biggest study of serotonin’s effects on humans, it found no direct relationship9 with depression. Professor Andrew Skull of Princeton has said attributing depression to low serotonin is “deeply misleading and unscientific.” (Location 576)

Tags: depression, serotonin

Note: .serotonin .depression

The clinical psychologist Dr. Lucy Johnstone14 was more blunt still. “Almost everything you were told was bullshit,” she said to me over coffee. The serotonin theory “is a lie. I don’t think we should dress it up and say, ‘Oh, well, maybe there’s evidence to support that.’ There isn’t.” (Location 619)

Tags: depression, serotonin

Note: .serotonin serotonin levels not cause of depression

designed to make it extraordinarily easy to get a drug approved. All you have to do is produce two trials—any time, anywhere in the world—that suggest some positive effect of the drug. If there are two, and there is some effect, that’s enough. So you could have a situation in which there are one thousand scientific trials, and 998 find the drug doesn’t work at all, and two find there is a tiny effect—and that means the drug will be making its way to your local pharmacy. (Location 643)

Tags: clinicaltrials, pharma, regulation

Note: you only have to produce 2 trials which show a positive results. The number of failed trials doesnt matter

Some people said to Irving—so what? Okay, so say it’s a placebo effect. Whatever the reason, people still feel better. Why break the spell? He explained: the evidence from the clinical trials suggests that the antidepressant effects are a largely a placebo, but the side effects are mostly the result of the chemicals themselves, and they can be very severe. (Location 651)

Tags: side effect, deppression, placebo

Note: although the positive effects of anti-depressants are mostly placebo, the side effects are because of the chemicals in the drug

The people who turn up at this center have a strong incentive to pretend to have any condition they happen to be studying there—and the for-profit companies conducting the clinical trials have a strong incentive to pretend to believe them. Peter looked on as both sides seemed to be effectively bullshitting each other. When he saw people being asked to rate how well the drugs had worked, he thought they were often clearly just giving the interviewer whatever answer they wanted. So Peter concluded that the results from clinical trials of antidepressants—all the data we have—are meaningless. That means Irving is building his conclusion that their effect is very small (at best) on a heap of garbage, Peter declared. The trials themselves are fraudulent. (Location 719)

Tags: clinicaltrial, pharma

Note: the people who partake in clinical trials are incentivised to pretend to have conditions

Somebody once told me1 that giving a person a story about why they are in pain is one of the most powerful things you can ever do. Taking away the story for your pain is just as powerful: I felt like I was on a rocky ship and somebody had taken away the railings. (Location 781)

Tags: story

Note: .story give someone a story about their pain

But as doctors first started to apply this checklist, they discovered something awkward. Almost everybody who is grieving, it turns out, matches the clinical criteria for depression. If you simply use the checklist, virtually anyone who has lost someone should be diagnosed as having a clear mental illness. (Location 830)

Tags: grieving, depression

Note: .depression almost everyone who is grieving would qualify as depressed according to the nine signs used by doctors

So the authors of the DSM invented a loophole, which became known as “the grief exception.”

They said that you are allowed to show the symptoms of depression and not be considered mentally ill in one circumstance and one circumstance only—if you have recently suffered the loss of somebody close to you.

After you lose (say) a baby, or a sister, or a mother, you can show these symptoms for a year before you are classed as mentally ill. But if you continued to be profoundly distressed after this deadline, you will still be classified as having a mental disorder.

As the years passed and different versions of the DSM were published, the time limit changed: it was slashed to three months, one month, and eventually just two weeks. (Location 832)

Tags: depression

Note: you only have 2 weeks after a loss before showing signs would qualify as depression

We grieve because we have loved.” (Location 842)

Tags: love, grieve

Note: .grieve we grieve because we have loved

The grief exception revealed something that the authors of the DSM—the distillation of mainstream psychiatric thinking—were deeply uncomfortable with. They had been forced to admit, in their own official manual, that it’s reasonable—and perhaps even necessary—to show the symptoms of depression, in one set of circumstances. But once you’ve conceded that,4 it invites an obvious follow-up question. Why is a death the only event that can happen in life where depression is a reasonable response? Why not if your husband has left you after thirty years of marriage? Why not if you are trapped for the next thirty years in a meaningless job you hate? Why not if you have ended up homeless and you are living under a bridge? If it’s reasonable in one set of circumstances, could there also be other circumstances where it is also reasonable? (Location 854)

Tags: depression

Note: .depression why is grief the only exception

What if depression is, in fact, a form of grief—for our own lives not being as they should? What if it is a form of grief for the connections we have lost, yet still need? (Location 905)

Tags: grief, depression

Note: .depression

So George and Tirril had discovered that two things make depression much more likely—having a severe negative event, and having long-term sources of stress and insecurity in your life. But the most startling result was what happened when these factors were added together. Your chances of becoming depressed didn’t just combine: they exploded. For example—if you didn’t have any friends, and you didn’t have a supportive partner, your chances of developing depression when a severe negative life event came along were 75 percent.11 It was much more likely than not. (Location 1026)

As they crunched the numbers, George and Tirril had discovered people living in poverty were more likely to become depressed—but the data showed it was too crude to say the poverty caused the depression. No: something more subtle was happening. People in poverty were more likely to become depressed because on average they faced more long-term stress, and because more negative life events happened to them, and because they had fewer stabilizers. But the underlying lessons were true for everyone, rich, middle-class, or poor. We all lose some hope when we’re subjected to severe stress, or when something horrible happens to us, but if the stress or the bad events are sustained over a long period, what you get is “the generalization of hopelessness,” Tirril told me. It spreads over your whole life,15 like an oil slick, and you begin to want to give up. (Location 1048)

Tags: poverty

Note: People in poverty face more long term stresses, and more negative life events so are much more likely t obecome depressed

But George and Tirril explained that they had, all along, been studying women who had been classified by psychiatrists as having “reactive depression” and women classified as having “endogenous depression.” And what they found—when they compared the evidence—is there was no difference between them. Both groups had things going wrong in their lives at the same rate. This distinction, they concluded, was meaningless. (Location 1070)

It was only a long time into talking with these social scientists that I realized every one of the social and psychological causes of depression and anxiety they have discovered has something in common. They are all forms of disconnection. They are all ways in which we have been cut off from something we innately need but seem to have lost along the way. (Location 1126)

Tags: disconnection

Note: control, reward and purpose

“You have to be challenged in a healthy way,” he told me, shrugging a little; I think he felt embarrassed to say it. “You have to know that your voice counts. You have to know that if you have a good idea, you can speak up, and change something.” He had never had a job like that, and he feared he never would. (Location 1163)

Note: You need to be able to voice ideas and be heard

If you worked in the civil service and you had a higher degree of control8 over your work, you were a lot less likely to become depressed or develop severe emotional distress than people working at the same pay level, with the same status, in the same office, as people with a lower degree of control over their work. (Location 1279)

Tags: control, depression

Note: .depression .control the level of control ou have in your job impacts likelihood of depression

“When work is enriching, life is fuller, and that spills over into the things you do outside work,” he said to me. But “when it’s deadening,” you feel “shattered at the end of the day, just shattered.” (Location 1298)

Tags: work

Note: .work enjoyable work spills over into other areas of life

“Disempowerment,” Michael told me, “is at the heart12 of poor health”—physical, mental, and emotional. (Location 1305)

Despair often happens, he had learned, when there is a “lack of balance between efforts and rewards.” (Location 1319)

Tags: work, depression

Note: .depression .work rewards foor good work are important

It’s worth repeating. Being deeply lonely seemed to cause as much stress as being punched by a stranger. (Location 1398)

Tags: lonely

When he put lonely people into brain-scanning machines, he noticed something. They would spot potential threats within 150 milliseconds, while it took socially connected people twice as long, 300 milliseconds, to notice the same threat. What was happening? Protracted loneliness causes you to shut down socially, and to be more suspicious of any social contact, he found. You become hypervigilant. You start to be more likely to take offense where none was intended, and to be afraid of strangers. You start to be afraid of the very thing you need most. John calls this a “snowball” effect, as disconnection spirals into more disconnection. (Location 1551)

Tags: lonely, depression

Note: .depression lonely people may take offence more easily

To end loneliness, you need other people—plus something else. You also need, he explained to me, to feel you are sharing something with the other person, or the group, that is meaningful to both of you. You have to be in it together—and “it” can be anything that you both think has meaning and value. (Location 1576)

Tags: lonely

Loneliness isn’t the physical absence of other people, he said—it’s the sense that you’re not sharing anything that matters with anyone else. (Location 1584)

Tags: lonely

you can ask people lots of other questions—and one of them is whether they are unhappy or if they are suffering (or have suffered) from depression or anxiety. Then—as a first step—you see if they match. Tim’s first tentative piece of research was to give this survey to 316 students. When the results came back4 and were all calculated out, Tim was struck by the results: materialistic people, who think happiness comes from accumulating stuff and a superior status, had much higher levels of depression and anxiety. (Location 1784)

Tags: depression, materialism

Note: .materialism .depression those valuing material posessions were more likely to be depressed

All of us have certain innate needs—to feel connected, to feel valued, to feel secure, to feel we make a difference in the world, to have autonomy, to feel we’re good at something. Materialistic people, he believes, are less happy—because they are chasing a way of life that does a bad job15 of meeting these needs. What you really need are connections. But what you are told you need, in our culture, is stuff and a superior status, and in the gap between those two signals—from yourself and from society—depression and anxiety will grow as your real needs go unmet. (Location 1882)

Tags: materialism

Note: materialism is a junk value

For millennia, humans have talked about something called the Golden Rule. It’s the idea that you should do unto others as you would have them do unto you. Tim, I think, has discovered something we should call the I-Want-Golden-Things Rule.17 The more you think life is about having stuff and superiority and showing it off, the more unhappy, and the more depressed and anxious, you will be. (Location 1901)

Tags: depression, materialism

Note: I want golden things rule - the more you think life is about showing off and having stuff the more depressed and anxious you will be

“The first thing is for people to ask themselves—Am I setting up my life so I can have a chance of succeeding at my intrinsic values? Am I hanging out with the right people, who are going to make me feel loved, as opposed to making me feel like I made it? … Those are hard choices sometimes.” But often, he says, you will hit up against a limit in our culture. You can make improvements, but often “the solutions to the problems that I’m interested in can’t be easily solved at the individual person level, or in the therapeutic consulting room, or by a pill.” They require something more—as I was going to explore later. (Location 2008)

most people who have studied the scientific evidence accept that there are three different kinds of causes of depression and anxiety—biological, psychological, and social. (Location 2207)

The psychologist Paul Gilbert started to make the case that depression is, for humans, in part a “submission response”—the evolutionary equivalent of Job, the baboon at the bottom of the hierarchy, saying—No, no more. Please, leave me alone. You don’t have to fight me. I’m no threat to you. (Location 2301)

Robert had discovered that having an insecure status was the one thing even more distressing than having a low status. So it seemed like there might be something in the theory that depression and anxiety are a response to the constant status anxiety many of us live with today. (Location 2310)

Tags: anxiety, security, status

Note: .status being cooncerned about our status may induce depression

The more unequal your society, the more prevalent all forms of mental illness are. Other social scientists then broke this down to look at depression specifically16—and found the higher the inequality, the higher the depression. This is true if you compare different countries,17 and if you compare different states within the United States. It strongly suggested that something about inequality seems to be driving up depression and anxiety. (Location 2326)

Tags: depression, equality

Note: .equality .depression more unequal countries see higher rates of depression, as there is further to fall

When you have a society with huge gaps in income and status, Richard told me, it creates the sense that “some people seem supremely important, and others seem of no importance at all.”

This doesn’t affect only people at the bottom. In a highly unequal society, everyone has to think about their status a lot. Am I maintaining my position? Who’s threatening me? How far can I fall? Just asking these questions—as you have to when inequality grows—loads more and more stress into our lives. (Location 2331)

Tags: equality

Note: .equality in highly unequal societies people worry about how far they can fall

It’s been known for a long time that all sorts of mental health problems5—including ones as severe as psychosis and schizophrenia—are considerably worse in cities than in the countryside, (Location 2433)

Tags: depression

Note: .depression depression is worse in cities than the countryside

“The thing is that we are animals. We keep forgetting that,” and as animals—she indicated toward her body—“this thing is made to move.” When we look for solutions to our bad feelings, she says, we try to find it in language, and in the symbols we have created as a species. But these symbols are—in the long sweep of things—very recent. “We have been vertebrate for nearly five hundred million years now. We’ve been mammals for two hundred fifty, three hundred million years. We’ve been primates for sixty-five [million years].” All those years she spent in the Congolese rain forest, living and sleeping and eating with the bonobos, she explained, she was being educated in how close we are to them. “We have been animals that move for a lot longer than we have been animals that talk and convey concepts,” she said to me. “But we still think that depression can be cured by this conceptual layer. I think [the first answer is more] simple. Let’s fix the physiology first. Get out. Move.” (Location 2462)

Tags: depression

Note: .depression we are all animals. We are made to move

When you are depressed—as Isabel knows from her own experience—you feel that “now everything is about you.” You become trapped in your own story and your own thoughts, and they rattle around in your head with a dull, bitter insistence. Becoming depressed or anxious is a process of becoming a prisoner of your ego, where no air from the outside can get in. But a range of scientists have shown that a common reaction15 to being out in the natural world is the precise opposite of this sensation—a feeling of awe. Faced with a natural landscape, you have a sense that you and your concerns are very small, and the world is very big—and that sensation can shrink the ego down to a manageable size. “It’s something larger than yourself,” Isabel said, looking around her. “There’s something very deeply, animally healthy in that sensation. (Location 2496)

Tags: depression

Note: .depression getting out into nature shows you how small you are, and reducrs your focus on yourself

A brain scan is “a snapshot of a moving picture,” he says. “You can take a snapshot of any moment in a football game—it doesn’t tell you what’s going to happen next, or where the brain is going.” The brain changes as you become depressed and anxious, and it changes again when you stop being depressed and anxious. It’s always changing in response to signals from the world. (Location 2795)

Note: A brainscan is a snapshot in time, annd does not predict what is has or will look like

Depression and anxiety are “not like a tumor, where something is growing in the brain because there is a real fuck-up in the tissue which precedes the psychological problems,” he says. “It’s not like that. They”—the distress caused by the outside world, and the changes inside the brain—“come together.” (Location 2807)

Tags: depression

Note: .depression depression is caused by the outside world

while it’s wrong to say the origin of these problems is solely within the brain, it would be equally wrong to say that the responses within the brain can’t make it worse. They can. The pain caused by life going wrong can trigger a response that is “so powerful that [the brain] tends to stay there [in a pained response] for a while, until something pushes it out of that corner, into a more flexible place.” And if the world keeps causing you deep pain, of course you’ll stay trapped there for a long time, with the snowball growing. (Location 2820)

“Ask not what’s inside your head,”9 he said. “Ask what your head’s inside of.” (Location 2832)

Your genes can certainly make you more vulnerable, but they don’t write your destiny. We all know how this works when it comes to weight. Some people find it really hard to put on weight: they can guzzle Big Macs and remain bone-thin. But some other people (cough, cough) have only to eat one fun-size Snickers for us to start to look like whales on Boxing Day. (Location 2867)

The genetic factors that contribute to depression and anxiety are very real, but they also need a trigger in your environment or your psychology. Your genes can then supercharge those factors, but they can’t create them alone. (Location 2873)

Note: Genes can contribute to depression when in the right environmennt

And if the standards of the culture were wrong then, I realized, they can be wrong now. You can have everything a person could possibly need by the standards of our culture—but those standards can badly misjudge what a human actually needs in order to have a good or even a tolerable life. The culture can create a picture of what you “need” to be happy—through all the junk values I had been taught about—that doesn’t fit with what you actually need. (Location 2925)

Tags: socialnorms

Note: .socialnorms you have everything needed, as judged by societial norms, but these norms may be wrong and dpnt cover what humans really need

depression and anxiety have three kinds of causes:23 biological, psychological, and social. (Location 2981)

One reason why is that it is “much more politically challenging” to say that so many people are feeling terrible because of how our societies now work. It fits much more with our system of “neoliberal capitalism,” he told me, to say, “Okay, we’ll get you functioning more efficiently, but please don’t start questioning … because that’s going to destabilize all sorts of things.” (Location 2992)

Tags: depression

“The pharmaceutical [companies] are major forces shaping a lot of psychiatry, because it’s this big, big business—billions of dollars,” he said. They pay the bills, so they largely set the agenda, and they obviously want our pain to be seen as a chemical problem with a chemical solution. The result is that we have ended up, as a culture, with a distorted sense of our own distress. (Location 2996)

the biggest division between the old story about depression and anxiety and the new story. The old story says our distress is fundamentally irrational, caused by faulty apparatus in our head. The new story says our distress is—however painful—in fact rational, and sane. (Location 3009)

Note: .depression

“It is no measure of health to be well-adjusted to a sick society.” (Location 3013)

Tags: societal norms

If you decide to pursue happiness in the United States or Britain, you pursue it for yourself—because you think that’s how it works. You do what I did most of the time: you get stuff for yourself, you rack up achievement for yourself, you build up your own ego. But if you consciously pursue happiness in Russia or Japan or China, you do something quite different. You try to make things better for your group—for the people around you. That’s what you think happiness means, so it seems obvious to you. These are fundamentally conflicting visions of what it means to become happier. And it turns out—for all the reasons I described earlier—that our Western version of happiness doesn’t actually work—whereas the collectivist vision of happiness does. (Location 3431)

“The more you think happiness is a social thing, the better off you are,” (Location 3437)

Tags: happiness

Note: .happiness view happiness as a colective rather than i dividually

As I sat with Meredith and watched the bike repairs happening all around us, I remembered what I had learned from Michael Marmot, the social scientist who carried out the research into British civil servants that showed the ways in which our work can make us sick, physically or mentally. He had explained to me: It’s not the work itself that makes you sick. It’s three other things. It’s the feeling of being controlled—of being a meaningless cog in a system. It’s the feeling that no matter how hard you work, you’ll be treated just the same and nobody will notice—an imbalance, as he puts it, between efforts and rewards. And it’s the feeling of being low on the hierarchy—of being a low-status person who doesn’t matter compared to the Big Man in the corner office. (Location 3924)

Tags: depression

Note: .depression at work it is encouraged by loss of control, not being rewarded/praised and feeling low on the hierachy

When there is pollution in the air that makes us feel worse, we ban the source of the pollution: we don’t allow factories to pump lead into our air. Advertising, he says, is a form of mental pollution. So there’s an obvious solution. Restrict or ban mental pollution, just like we restrict or ban physical pollution. (Location 4013)

Tags: advertising

Note: .advertising ads are mental pollution

Nathan had been reading up on the evidence about how we come to crave all this stuff. He learned that the average American is exposed to up to five thousand advertising impressions a day—from billboards to logos on T-shirts to TV advertisements. It is the sea in which we swim. And “the narrative is that if you [buy] this thing, it’ll yield more happiness—and so thousands of times a day you’re just surrounded with that message,” (Location 4077)

Tags: ads

Note: .ads

Tim had shown before that materialism correlates strongly with increased depression and anxiety. This experiment showed, for the first time, that it was possible to intervene in people’s lives in a way that would significantly reduce their levels of materialism. The people who had gone through this experiment had significantly lower materialism and significantly higher self-esteem. It was a big and measurable effect. (Location 4122)

Tags: materialism

Note: .materialism materialism reduces happiness

Nobody claims that psychedelics work in the way we were told antidepressants did in the 1990s: they don’t change your brain chemistry and therefore “fix” you. No. What they do is give you—when the experience goes well—a remarkable sense of connection, for a very short period. “The value of the experience,” Andrew told me, is to “show you the possibility”—how connection can make you feel. Then, he says, “it’s up to you to find other ways to maintain the experience.” Its value is not as a drug experience but as a learning experience. And you need to keep practicing the lesson, one way or another. (Location 4566)

Tags: drugs

Note: .drugs drugs show you the possible connections, you must then find other ways to maintain this

What this suggests is it’s not just the childhood trauma in itself that causes these problems, including depression and anxiety—it’s hiding away the childhood trauma. It’s not telling anyone because you’re ashamed. When you lock it away in your mind, it festers, and the sense of shame grows. As a doctor, Vincent can’t (alas) invent time machines to go back and prevent the abuse. But he can help his patients to stop hiding, and to stop feeling ashamed. (Location 4637)

That doesn’t mean all chemical antidepressants are bad: some credible scientists argue they give some temporary relief to a minority of users, and that shouldn’t be dismissed. The false story is the claim that depression is caused by a chemical imbalance in the brain and that the primary solution for most people is a chemical antidepressant. That story has made Big Pharma over $100 billion,1 which is one of the crucial reasons why it persists. (Location 4871)

Depression and anxiety have three kinds of causes—biological, psychological, and social. (Location 4876)

You aren’t a machine with broken parts. You are an animal whose needs are not being met. You need to have a community. You need to have meaningful values, not the junk values you’ve been pumped full of all your life, telling you happiness comes through money and buying objects. You need to have meaningful work. You need the natural world. You need to feel you are respected. You need a secure future. You need connections to all these things. You need to release any shame you might feel for having been mistreated. (Location 4890)

Tags: depression

Note: .depression